WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of one of the six assessments under the psychiatric impairment rating scale categories, namely social and recreational activities; the challenged assessment was confirmed on appeal; Held - Medical Assessment Certificate confirmed.

1. The worker Mr Clinton McNeill (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Gerard Walsh, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 21 November 2025.
2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
   • the assessment was made on the basis of incorrect criteria, and
   • the MAC contains a demonstrable error.
3. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the grounds of appeal on which the appeal is made.
4. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
5. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed

1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. The appellant requested that he undergo a re-examination by a Medical Assessor who is also a Member of the Appeal Panel. As a result of its preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because the Appeal Panel did not find error. Absent a finding of error, the Appeal Panel has no power to require the worker undergo a re-examination: see New South Wales Police Force v Registrar of the Personal Injury Commission of New South Wales [2013] NSWSC 1792.

1. The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.

1. The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
3. The matter was referred to the Medical Assessor for assessment as follows:

"The following matters have been referred for assessment (s 319 of the 1998 Act):

• Date of injury: 13/07/2020
• Body parts/systems referred: Psychiatric/psychological disorder
• Method of assessment: whole person impairment."

1. The Medical Assessor issued a MAC certifying 9% whole person impairment (WPI) as a result of the injury as follows:

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

Total % WPI (the Combined Table values of all sub-totals)

1. The assessment was based on his assessment under psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows: (emphasis in original)

He is seeing a psychologist, Bill MacDonald, monthly currently.

Class 2 and not Class 1 was selected because he can live independently, looks after self adequately, although may look unkempt occasionally

Bathing: He said he showers when he thinks he needs to but his wife reminds him every second day to shower.

Cooking: The Claimant said his wife does all the cooking.

Household chores: He reported that his wife does all the chores.

He said he becomes frustrated when he tries to help. He does the mowing and exterior jobs around the house twice a week.

He stated that before the subject injury, he was completely independent in bathing, grooming, household chores and shopping. He said he fell out the routine 3 or 4 years ago because of how his mental health had been affected.

Class 2 and not Class 1 was selected because he is participating in social activities although not as much as in the past such as group activities.

Hobbies: He said he goes walking generally once a week with his wife for between 10 to 45 minutes.

Exercise: He said he goes walking generally once a week with his wife for between 10 to 45 minutes. The Claimant said a support person is not needed to go out to the beach. He said he goes paddle boarding alone once a month. He stated that he has to keep active for physical reasons such as yoga. He does not do group activities anymore.

Frequency of socialising: He said he only goes out socially with his wife or with family once every 6 weeks. He goes to restaurants once a month with his wife. He goes to friends' houses every 6 weeks. He goes to engagement parties when invited.

Involvement when out: He reported that he is involved in conversations but is not 'the life and soul of the party' that he used to be.

He said he wants to avoid interactions where he would be talking about the past workplace.

He stated that before the subject injury, he used to enjoy group activities such as paddle boarding and surf club but ceased around 2020.

Class 2 and not Class 1 was selected because he can travel without a support person locally.

The Claimant said a support person is not required to travel. He drives to the beach or shops. He cannot drive longer distances because of losing concentration.

He stated that he has been interstate or overseas since the subject injury to the UK for 3 weeks in August 2025 with his wife to see their son.

He said that in 2024 he went to Japan with his son and went to Queensland to have his car serviced and other trips around in the last year.

He stated that before the subject injury, he could travel anywhere without any problem.

Class 2 and not Class 1 was selected because he has maintained his close relationships. Tension and arguments with partner and he has had a loss of some friendships.

Relationship with his wife: He said he has been with his wife for around 40 years. There has been no domestic violence or periods of separation. He said he sometimes has outbursts and they have separate bedrooms.

Relationship with children: He stated that he has three adult children; 2 sons and one daughter. He said he has a good relationship with his children and is supportive.

Relationship with siblings: The Claimant said he has three brothers and one sister. He said he has a reasonable relationship with one brother and his sister.

Relationship with parents: He reported that his mother died last week. His father is deceased.

Relationship with friends: He stated that he tries to avoid his old colleagues. He has a handful of friends and tries to speak to them once a fortnight. He visits friends every 6 weeks.

He stated that before the subject injury, he went out with family and friends often. Problems began around 2021. He said his relationship with his brother was affected because his mood changed after leaving the Fire Brigade. They have not reconciled since.

Class 3 and not Class 2 was selected because he finds it difficult to follow complex instructions. He managed the 1 hour and 5 minutes assessment well and had no difficulty sustaining his concentration.

He said his concentration was currently poor because he loses interest after 20 minutes. He said that he can read newspaper articles but struggles with instructions when he searches the internet. He cannot follow Spanish which he had previously been learning. He said he brings his wife to clinical appointments as he cannot recall what has been discussed.

He said his concentration was good before the subject injury. He said he used to be an avid reader and could read for hours. He said around 2020 or 2021 this changed. He used to play guitar but has only played it 3 times in the past year and was frustrated that he could not remember songs.

Class 5 and not Class 4 was selected because he cannot work at all.

He stopped working for the Fire Service on 18/01/2022 but was medically discharged from work on 12/01/2023.

Volunteering: He stated that he does not do any unpaid work.

He said the barriers to returning to work were not trusting himself on jobs because of anxiety. He said he is inaccurate with his tools as his hands shake which would be dangerous working as an electrician.

He stated that there were never any issues with employment before the subject injury.

PIRS classes were 2, 2, 2, 2, 3, 5. Thus, the aggregate was 16.

In ascending order: 2, 2, 2, 2, 3, 5. The median was Class 2.

This gave the final Whole Person Impairment of 9%."

1. The worker appealed.
2. In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments he made under one of the six PIRS categories, namely social and recreational activities causing him to make an error in the assessment in this domain as follows:

(a) in assessing Class 3 for social and recreational activities when he should have assessed Class 2.

1. In summary, the employer State of New South Wales (Fire & Rescue NSW) (the respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. It was submitted the findings were open to the Medical Assessor applying his clinical expertise to the assessment. It was submitted that the appellant is merely cavilling with the opinion of the Medical Assessor and the appeal should fail.
2. The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.
3. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self-report can be properly evaluated in the context of other evidence before the Medical Assessor.
4. The Medical Assessor recorded a history as follows: (emphasis in original)

"● A brief history of the incident/onset of symptoms and subsequent related events, including treatment as per the Claimant on the date of assessment:

The documentation indicated that the Claimant was exposed to traumatic events in the course of his work as a firefighter between 1988 and 2002. He did not seek any treatment and was unaware of any psychological symptoms until 2022. During his time as a firefighter, five colleagues died by suicide.

It was documented that he identified the trigger for his psychological symptoms as the death by suicide of his work colleague and friend on 13/07/2020. He was due to work with him that day, but instead was part of a search team who found and identified his colleague's body. He had the task of informing his colleague's family about his death. He received some psychological counselling through Fire and Rescue NSW by telehealth but did not find it helpful.

It was documented that in November 2020, he began seeing his psychologist, Bill MacDonald.

It was documented that between 2020 and 2022, his alcohol consumption increased, and he took time off work for two surgeries to his elbow and lower back injury.

It was documented that in January 2022, he attended an attempted suicide in the course of his work which he found retraumatising.

He stopped working on 18/01/2022 but was medically discharged from work on 12/01/2023.

The Claimant's report of the subject injury of 13/07/2020 (as dated in the PIC documentation):

The Claimant said that during his career, he witnessed accidents, deaths and colleagues dying by suicide. He said that when he was younger, he could 'maintain a brave face' and carry on. He said he did not recall any counselling after any of the traumatic workplace events that he attended.

The Claimant described the day of 13/07/2020 saying that his colleague was supposed to turn up for work. He said that they had searched for him, but he had jumped off a cliff. The Claimant said it was very difficult having to inform the man's family. He was tearful relating what occurred that day. He said he felt that he had changed as a person because of what had occurred at work.

The Claimant said the response from the service about his friend's death was, 'Don't talk about it. Just get on with it'. He then said in 2020, he did have some counselling arranged by the workplace but felt it was impersonal, and he did not think it helped in any way.

The Claimant said that later in 2020, after his friend's death, a girl had been on a ledge for days and attempting to die by suicide. This negatively impacted the Claimant as it reminded him of his friend's death to the extent that he could no longer manage working for the Fire and Rescue Service and so left the service.

The Claimant said that mirtazapine commenced around 2020 and that it helps him sleep and feel relaxed. He was unsure if it improved his mood.

He said he began seeing his psychologist, Bill MacDonald, at Mona Vale in November 2020 for monthly sessions and thought it was helpful.

The Claimant stated that his mood, sleep and concentration before the subject injury was good. He reported that all of his symptoms began around 2020 after his friend's suicide off a cliff.

He said the first time his mood symptoms occurred was around 2020 and have continued since without improvement for more than a few hours. He said he has lost 5kg over 3 years due to a poor appetite.

The Claimant said he began having nightmares after his friend's suicide and they occurred around once a week.

He said he used to be an avid reader and could read for hours but around 2020 or 2021 this changed. He used to play guitar but has only played it 3 times in the past year and was frustrated that he could not remember songs.

He said he could not recall having anxiety symptoms before 2020 but has had them since. He has never had panic attacks.

He stated that before the subject injury, he was completely independent in bathing, grooming, household chores and shopping. He said he fell out of the routine 3 or 4 years ago because of how his mental health had been affected. He used to enjoy group activities such as paddle boarding and surf club but ceased group activities around 2020.

He stated that before the subject injury, he could travel anywhere without any problem and went out with family and friends often. He said his relationship with his brother was affected because his mood changed after leaving the Fire Brigade.

He stated that there were never any issues with employment before the subject injury.

Anhedonia - He has some improvement in mood when he is with his family.

Sleep - He described his sleep as the symptom which bothers him most and uses medications and beers to help sleep. He said around once a month he has nightmares regarding the workplace traumatic events, including the subject injury.

Fatigue - He stated that he naps most days due to fatigue.

Negative thoughts - He said he was useless; he cannot provide adequately for his family and feels worthless.

Concentration - He said his concentration was currently poor because he loses interest after 20 minutes. He said that he can read newspaper articles but struggles with instructions when he searches the internet. He cannot follow Spanish which he had previously been learning. He said he brings his wife to clinical appointments as he cannot recall what has been discussed.

Suicidal - He said he was not experiencing suicidal thoughts.

He denied ever having experienced hypomanic or manic symptoms before.

Frequency - He said anxiety episodes occur daily and can last for an hour or all day.

Triggers - He stated that anxiety episodes were triggered by any reminder of the traumatic workplace events, being around cliffs, and hearing or seeing emergency vehicles as they remind him of his friend's death in 2020. Minor issues and not knowing how to handle situations can also cause anxiety.

The Claimant reported that symptoms of anxiety include increased heart rate, shaking, choking, and chest discomfort.

Intrusive thoughts - There were intrusive thoughts about the subject injury twice a week or more often.

Dreams - He said he has nightmares regarding the workplace traumatic events, including the subject injury, around once a month.

Flashbacks - There were flashbacks about the subject injury usually if he is triggered once a week.

Psychological distress - There was psychological distress from stimuli associated with the subject injury.

Physiological distress - Physiological anxiety symptoms experienced when exposed to triggers of the subject injury are described in the anxiety section above.

Avoidance of thoughts - He said he avoided reminders of the subject injury such as avoiding work colleagues, avoiding cliffs, and he takes other routes to avoid going past fire stations.

Negative thoughts - There were negative thoughts. He said he was useless; he cannot provide adequately for his family and feels worthless.

Distorted cognitions - There were distorted cognitions in that he thinks about what more he should have done in those workplace incidents he attended.

Negative emotional state - There was negative emotional state such as anger about some of what happened. He said he felt 'devastated' about some of the workplace traumatic incidents he attended, about what he should have done.

Diminished interest - He said he had diminished interest in some previously enjoyed activities.

Detachment - He said he did not feel emotionally detached from family and friends.

No positive emotions - He said he could experience positive emotions.

Irritable - He reported being irritable with others.

Concentration - He said his concentration was currently poor because he loses interest after 20 minutes. He said that he can read newspaper articles but struggles with instructions when he searches the internet. He cannot follow Spanish which he had previously been learning. He said he brings his wife to clinical appointments as he cannot recall what has been discussed.

Sleep - He described his sleep as the most significant symptom which bothers him most and uses medications and beers to help with sleep. He said he has nightmares regarding the workplace traumatic events, including the subject injury, around once a month.

He said he has been taking analgesia for his back and elbow.

• Current treatment as per the Claimant on 19/11/2025:

He is seeing a psychologist, Bill MacDonald, monthly currently.

There are no current plans for treatment escalation or medication changes.

He is motivated for further escalation of treatment.

The timeline of symptoms is given in the 'History relating to the Injury' section.

• Details of any previous or subsequent accidents, injuries, or conditions:

The Claimant said he had a workers Compensation injury in 2021 to his left elbow which was struck by an object from a motor vehicle he attended in the course of his work. He said did not experience any mental issues due to that injury.

He has had previous workplace physical injuries and had back surgery with limited outcome.

The Claimant denied experiencing any psychiatric or psychological disorder before the subject injury.

The Claimant denied any prior engagement with mental health services or admissions to mental health units.

The Claimant also denied ever having any history of previous self-harming behaviours, suicide attempts or harm towards others.

The Claimant said he had not sustained any injuries or conditions since the subject injury.

The Claimant said he drinks 2 to 3 beers daily to relax.

He denied any maladaptive drinking patterns or hazardous behaviour whilst using alcohol.

He denied any history of substance use or problem gambling.

He said his mother had been diagnosed bipolar. He said that when he was growing up and she was unwell, it did not affect his mental health.

He was born in the UK and has three brothers and one sister.

The family moved to Australia when he was four years old.

He said he had a happy childhood and that there was no trauma while growing up.

The Claimant dropped out of secondary school in Year 11. He said he began a TAFE accountancy course but only did the entry course for a few months because he did not like it.

• Work history, including previous work history if relevant:

After finishing school, he completed an electrician apprenticeship.

In 1984, he began working full-time as a beach inspector and lifeguard.

In 1988, he joined Fire and Rescue New South Wales as a firefighter.

He said he worked in his own business until 2021 as an electrician whilst still working as a firefighter.

He has had previous physical issues which were related to workplace injuries. He had previous back surgery with limited outcome.

He said that Multiple Myeloma was diagnosed in 2023. He said it does not affect him physically or psychologically because he is being monitored by his physicians. The Claimant said he is not concerned about it as it has been stable.

He stated that before the subject injury, he was completely independent in bathing, grooming, household chores and shopping. He said he fell out the routine 3 or 4 years ago because of how his mental health had been affected.

Bathing: He said he showers when he thinks he needs to,d but his wife reminds him every second day to shower.

Cooking: The Claimant said his wife does all the cooking.

Household chores: He reported that his wife does all the chores.

He said he becomes frustrated when he tries to help. He does the mowing and exterior jobs around the house twice a week.

On 09/01/2023 and 11/12/2024, Dr Richa Rastogi wrote: Self-care and personal hygiene Class 2. He struggles with self-care and maintaining a routine

On 09/07/2024, Dr Naresh Verma wrote: Self-care and personal hygiene Class 2. Need some prompting with self-care and takes a shower every second day and can stay in the same clothes for a few days.

He stated that before the subject injury, he used to enjoy group activities such as paddle boarding and surf club but ceased going to group activities around 2020.

Exercise: He said he goes walking generally once a week with his wife for between 10 to 45 minutes. The Claimant said a support person is not needed to go out to the beach. He said he goes paddle boarding alone once a month. He stated that he has to keep active for physical reasons such as yoga. He does not do group activities anymore.

Frequency of socialising: He said he only goes out socially with his wife or with family once every 6 weeks. He goes to restaurants once a month with his wife. He goes to friends' houses every 6 weeks. He goes to engagement parties when invited.

Involvement when out: He reported that he is involved in conversations but is not 'the life and soul of the party' that he used to be.

He said he wants to avoid interactions where he would be talking about the past workplace.

On 09/01/2023 and 11/12/2024, Dr Richa Rastogi wrote: Social and Recreational Class 3. Socially he is isolated and reclusive. He does not enjoy travelling as much and in high stimulus environments, does not participate in social events, prefers his own company.

On 09/07/2024, Dr Naresh Verma wrote: Social and Recreational Class 2. He tries to do some walking and cycling though he does not swim or paddle board as much. There is some social isolation from friends. I do not believe he is Class 3 as it implies significant impairment whereas he is actually able to do some recreational activities.

On 05/02/2025, the Desktop Investigation Report, Procare C&A Investigations had an image from social media of the Claimant with a band in the background, Snippets of Tamworth. He indicated that he was there for 10 days and enjoying it.

He stated that before the subject injury, he could travel anywhere without any problem.

The Claimant said a support person is not required to travel. He drives to the beach or shops. He cannot drive longer distances because of losing concentration.

He stated that he has been interstate or overseas since the subject injury to the UK for 3 weeks in August 2025 with his wife to see their son.

He said that in 2024 he went to Japan with his son and went to Queensland to have his car serviced and other trips around in the last year.

On 09/01/2023 and 11/12/2024, Dr Richa Rastogi wrote: Travel Class 2. He drives but only to familiar places gets easily triggered, feels overwhelmed easily

On 09/07/2024, Dr Naresh Verma wrote: Travel Class 2. Some difficulty in driving in certain areas, avoiding cliffs et cetera. If he gets dizzy while driving he tends to pull up.

He stated that before the subject injury, he went out with family and friends often. problems began around 2021. He said his relationship with his brother was affected because his mood changed after leaving the Fire Brigade. They have not reconciled since.

Relationship with his wife: He said he has been with his wife for around 40 years. There has been no domestic violence or periods of separation. He said he sometimes has outbursts and they have separate bedrooms.

Relationship with children: He stated that he has three adult children; 2 sons and one daughter. He said he has a good relationship with his children and is supportive.

Relationship with siblings: The Claimant said he has three brothers and one sister. He said he has a reasonable relationship with one brother and his sister.

Relationship with parents: He reported that his mother died last week. His father is deceased.

Relationship with friends: He stated that he tries to avoid his old colleagues. He has a handful of friends and tries to speak to them once a fortnight. He visits friends every 6 weeks.

On 09/01/2023 and 11/12/2024, Dr Richa Rastogi wrote: Social Function Class 2. He connects socially with family and avoids high stimulus environment, relationship with family further strained, feeling of burden on his wife.

On 09/07/2024, Dr Naresh Verma wrote: Social Function Class 2. The marital relationship is strained at times. He still enjoys time with his children and grandchildren.

He said his concentration was good before the subject injury. He said he used to be an avid reader and could read for hours. He said around 2020 or 2021 this changed. He used to play guitar but has only played it 3 times in the past year and was frustrated that he could not remember songs.

He said his concentration was currently poor because he loses interest after 20 minutes. He said that he can read newspaper articles but struggles with instructions when he searches the internet. He cannot follow Spanish which he had previously been learning. He said he brings his wife to clinical appointments as he cannot recall what has been discussed.

On 09/01/2023 and 11/12/2024, Dr Richa Rastogi wrote: Concentration, persistence and pace Class 3. He feels tired and exhausted and has limited attention span, struggles with problem solving

On 09/07/2024, Dr Naresh Verma wrote: Concentration, persistence and pace Class 3. He tends to reread the same book for the last two months.

He stated that there were never any issues with employment before the subject injury.

He stopped working for the Fire Service on 18/01/2022 but was medically discharged from work on 12/01/2023.

Volunteering: He stated that he does not do any unpaid work.

He said the barriers to returning to work were not trusting himself on jobs because of anxiety. He said he is inaccurate with his tools as his hands shake which would be dangerous working as an electrician.

On 09/01/2023 and 11/12/2024, Dr Richa Rastogi wrote: Adaptation and Employability Class 5. Total impairment as he has reduced pace and attention, anxiety with fears and avoidance behaviours and social anxiety

On 09/07/2024, Dr Naresh Verma wrote: Adaptation and Employability Class 5. Unfit for any work. Lacks focus, concentration, decision-making, problem-solving ability and has excessive anxiety."

1. The Medical Assessor undertook a mental state examination and recorded his findings as follows:

"Mental State on Examination as at Wednesday, 19/11/2025:

Appearance: The Claimant appeared his stated age and was well groomed.

Behaviour: There was no psychomotor disturbance, and he appeared relaxed in his chair. There was good eye contact with the videoconference camera. He became tearful talking about his friend's death in 13/07/2020.

Speech: Speech was spontaneous and normal in volume, rate, rhythm, and prosody.

Affect: His affect was warm, reactive, and appropriate, with a restricted range.

Thought form: The thought form was logical, with no formal thought disorder noted.

Thought content: The main themes were about the effects of the subject injury on his life. He said he was useless; he cannot provide adequately for his family and feels worthless.

There were no delusions noted. He said he was not experiencing suicidal thoughts.

Perceptions: There was no perceptual abnormality described, and he did not appear to be responding to any abnormality on observation.

Cognition: Formal testing of cognition was not performed. The Claimant attended the assessment alone and at the correct time. A reasonable history was obtained. He could manage the 1 hour and 5 minutes assessment well and had no difficulty sustaining his concentration."

1. The Medical Assessor summarised the injury and his diagnosis as follows:

He currently demonstrates enough symptoms to satisfy the diagnostic criteria for:

• ➢ Post-Traumatic Stress Disorder - as the circumstances of the subject injury are sufficient to meet Criterion A, and there are sufficient symptoms to meet Criterion B to E, with sufficient duration longer than a month, causing significant distress and impairment.
• ➢ Persistent Depressive Disorder - as there have been persistent depressive symptoms exceeding the minimum 2 years duration. Symptoms include low mood, anhedonia, poor appetite, poor sleep, and poor concentration.
• ➢ Alcohol abuse in remission - He was drinking much more heavily but has been able to moderate his drinking since.

The Claimant appeared consistent in his presentation."

1. The Medical Assessor rated impairment at 9% WPI based on his assessments under PIRS as set out in the table above.
2. The Medical Assessor explained that in making that assessment he took into account the following matters: (emphasis in original)

"The information from the assessment and my observations of the Claimant, which can be found above, as well as information from the relevant documents, have been summarised below:

Various Dates - Letter and clinical records, Bill MacDonald, Psychologist, Northside Psychology

09/11/2020 - It was documented that the Claimant had first consulted his psychologist on 09/11/2020 and that at the time he had Acute Stress Disorder then PTSD following a traumatic incident at work when he discovered his friend who had died by suicide.

09/05/2022 - It was documented that at the time, he reported symptoms which included insomnia, anxiety, depression, flashbacks, and ruminating thoughts.

At that time, his psychologist did not think he was able to return to any fire and rescue work environment.

16/10/2023 - The Claimant's psychologist documented that he continued to satisfy criteria for PTSD and experienced symptoms including flashbacks, agitation, insomnia, anxiety, depression, and ruminations.

09/01/2023 and 11/12/2024 - Dr Richa Rastogi - IME Consultant Psychiatrist

The history was in keeping with that summarised above in the 'History of the injury' section.

His alcohol consumption increased between 2020 and 2022.

Symptoms included chronic insomnia, feeling flat and mood, withdrawn, impaired concentration, experiences 'brain fog', irritability, and anger. He felt overwhelmed easily, was easily distracted, and struggled to make decisions. He had issues with motivation.

Major Depressive Disorder with depressed mood and anxious distress

At the time of that assessment, the prescribed medications were mirtazapine 15 mg daily, melatonin, Nurofen, aspirin, and Mobic. He was seeing a psychologist.

The opinion was that nature and condition of his work resulted in PTSD associated with suicide of five colleagues as well as exposure to multiple horrendous work incidents during his tenure as a fire fighter over 34 years.

He has had previous physical issues which were related to workplace injuries. He had previous back surgery with limited outcome.

Self-care and personal hygiene Class 2. He struggles with self-care and maintaining a routine

Social and Recreational Class 3. Socially he is isolated and reclusive. He does not enjoy travelling as much and in high stimulus environments, does not participate in social events, prefers his own company.

Travel Class 2. He drives but only to familiar places gets easily triggered, feels overwhelmed easily

Social Function Class 2. He connects socially with family and avoids high stimulus environment, relationship with family further strained, feeling of burden on his wife.

Concentration, persistence and pace Class 3. He feels tired and exhausted and has limited attention span, struggles with problem solving

Adaptation and Employability Class 5. Total impairment as he has reduced pace and attention, anxiety with fears and avoidance behaviours and social anxiety

PIRS classes were 2, 3, 2, 2, 3, 5. Thus, the aggregate was 17.

In ascending order: 2, 2, 2, 3, 3, 5. The median was Class 3.

Maximum medical improvement was considered to have been reached.

20/05/2024 and 05/02/2025 - Desktop Investigation Report, Procare C&A Investigations

The updated investigation report was documented to be 05/02/2024. Possibly this is a typographical error and should have been 2025 and not 2024.

There was an image of the Claimant with a band in the background, Snippets of Tamworth. He indicated that he was there for 10 days and enjoying it.

09/07/2024 - Dr Naresh Verma - IME Consultant Psychiatrist

The history was in keeping with that summarised above in the 'History of the injury' section.

He stopped working on 18/01/2022 but was medically discharged on 12/01/2023.

Symptoms included insomnia and nightmares. He would become distressed at seeing a fire trucks, hearing sirens, or TV reports. He avoided going to the beach in case he bumped into other firefighters. His relationship with his wife was strained. He was drinking around four beers or glasses of wine most days.

At the time of that assessment, the prescribed medications were mirtazapine 15 mg daily, melatonin, Nurofen, aspirin, and Mobic. He was seeing his psychologist, Bill MacDonald at Mona Vale monthly but did not have a regular psychiatrist. He had never tried any other antidepressant.

It was documented that some pain was associated with his impairment, but it was predominantly due to his PTSD symptoms.

He had back surgery in 2010 but had chronic back and leg pain.

Self-care and personal hygiene Class 2. Need some prompting with self-care and takes a shower every second day and can stay in the same clothes for a few days.

Social and Recreational Class 2. He tries to do some walking and cycling though he does not swim or paddle board as much. There is some social isolation from friends. I do not believe he is Class 3 as it implies significant impairment whereas he is actually able to do some recreational activities.

Travel Class 2. Some difficulty in driving in certain areas, avoiding cliffs et cetera. If he gets dizzy while driving he tends to pull up.

Social Function Class 2. The marital relationship is strained at times. He still enjoys time with his children and grandchildren.

Concentration, persistence and pace Class 3. He tends to reread the same book for the last two months.

Adaptation and Employability Class 5. Unfit for any work. Lacks focus, concentration, decision making, problem solving ability and has excessive anxiety.

PIRS classes were 2, 2, 2, 2, 3, 5. Thus, the aggregate was 16.

In ascending order: 2, 2, 2, 2, 3, 5. The median was Class 2.

Maximum medical improvement was considered to have been reached.

The history was noted. He continued to see his psychologist, Bill MacDonald.

1. The Medical Assessor made brief comment on the other medical opinion before him as follows:
2. My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs.

"My assessment of 9% WPI% agrees with the outcome of Dr Verma. Dr Rastogi's Social and Recreational Class 3 was the only difference. The description provided to Dr Rastogi did not appear to capture the other activities that he is still engages in and so I consider Dr Verma and my assessment better represents the function in this area. My reasoning for each specific domain is to be found within the PIRS."

1. The complaint on appeal concerns only one of the PIRS categories, namely social and recreation activities. The Medical Assessor assessed a mild impairment at Class 2 and the appellant submits that was in error and a moderate impairment should have been rated at Class 3. The appellant submitted that part of the reason the Medical Assessor made an error was because he failed to obtain and record an adequate history.
2. In respect of social and recreational activities, Table 11.2 of the Guides provides as follows:

Table 11.2: Psychiatric impairment rating scale - social and recreational activities

No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these.

Mild impairment: occasionally goes out to such events e.g. without needing a support person, but does not become actively involved (e.g. dancing, cheering favourite team).

Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.

Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.

Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.

1. The Medical Assessor assessed a Class 2 or mild impairment with the following reasoning: (emphasis in original)

"Class 2 and not Class 1 was selected because he is participating in social activities although not as much as in the past such as group activities.

Hobbies: He said he goes walking generally once a week with his wife for between 10 to 45 minutes.

Exercise: He said he goes walking generally once a week with his wife for between 10 to 45 minutes. The Claimant said a support person is not needed to go out to the beach. He said he goes paddle boarding alone once a month. He stated that he has to keep active for physical reasons such as yoga. He does not do group activities anymore.

Frequency of socialising: He said he only goes out socially with his wife or with family once every 6 weeks. He goes to restaurants once a month with his wife. He goes to friends' houses every 6 weeks. He goes to engagement parties when invited.

Involvement when out: He reported that he is involved in conversations but is not 'the life and soul of the party' that he used to be.

He said he wants to avoid interactions where he would be talking about the past workplace."

1. The Appeal Panel notes that the Medical Assessor has taken a through history from the appellant. He carefully records pre and post injury function. However it must be remembered that when assessing impairment under PIRS the relevant test is the level of impairment on the day of examination according to the criteria in the Guidelines. This does not mean that impairment is rated based on what an injured worker could do before the injury compared to what they are limited to now (technically known as an ipsative comparison). In other words it is not the diminution in functionality in the relevant domain that is rated. Instead, impairment is rated according to the criteria in the Guidelines based on what the worker is capable of doing as at the date of assessment using a normative comparison. The Medical Assessor cannot rely on self report alone but must also have regard to the other material before him and apply his clinical expertise in the rating of the impairment. This is exactly what the Medical Assessor has done here. He has taken a careful history. He is clearly cognisant of the other independent medical examiners (IME) opinions before him and specifically explains why he differs from the opinion of Dr Rastogi, the IME qualified to provide an opinion on behalf of the appellant and who rated a moderate impairment in this domain. The Appeal Panel notes that this rating was based on an examination done in January 2023 some 18 months prior to the assessment by the Medical Assessor. The Medical Assessor is required to make an independent assessment based on his findings on the day of examination to which his clinical expertise has been applied. The Appeal Panel considers that the impairment has been rated correctly at a mild impairment in accordance with the correct criteria in the Guidelines. To be rated a moderate impairment the frequency of his social and recreational activities would have to be rare and necessarily involve a support person. This is not the case here on the careful history taken by the medical assessor and supported by the other evidence before him.
2. The fact that the frequency of the appellant's social and recreational activities is reduced compared to prior to injury does not mean that that they are not regularly undertaken, and the assessor has identified a frequency of at least occasional recreational activities and socialising with his partner and friends which is part of what forms the basis for the assessment of a mild impairment in accordance with the correct application of the criteria in the Guidelines. Even though he is not the "life of the party" as before, the appellant gives a history that he is involved in conversations whilst undertaking social and recreational activities, so this does not mean the impairment is moderate. The test is whether the worker can participate in social and recreational activities, not whether he does so with anxiety or enjoyment or that he is not as actively involved as before the injury. An assessment of moderate impairment requires rare participation in social and recreational activities and only with a support person in attendance. This is not the case here. The regular social and recreational activities undertaken by the appellant and as carefully set out in the history taken by the Medical Assessor is not consistent with a rating of a moderate impairment. It is consistent with a rating of a mild impairment at Class 2 as rated by the Medica Assessor and there is no error.
3. For these reasons, the Appeal Panel has determined that the MAC issued on